卫气昼夜运行速度季节性变化对留针时间影响的理论文献研究

【作者】 金秀年；

【导师】 翟双庆；

【作者基本信息】 北京中医药大学 ， 中医基础理论， 2011， 博士

【摘要】 针灸治疗中得气与留针是取得疗效的前提,但对所得之气为何气、留针之暂久的依据却鲜有人研究,造成临床上对留针时间的忽视。本文从文献研究出发,对以上两个问题进行了深入探讨,旨在用《内经》理论阐释得气的本源与留针的依据,初构四时留针模型,对针灸临床起到一定的指导作用。本章从卫气的基本功能、与营气的关系入手进行分析,明确了针灸治疗中所得之气为卫气,进而,根据卫气昼夜运行规律,重点研究卫气运行与留针时间的关系。从卫气运行速度季节性变化角度对留针时间进行了探讨,得出不同季节留针应取不同时长的结论。最后初步构建了四时留针模型,以期对提高临床疗效发挥一定作用。论文分为三部分,并附结语：第一部分为对卫气和营气及得气的概念进行分析。营卫之气就其概念而言,卫气和营气是中医学中一对重要的概念,两者均不能脱离一方单独阐释,因此,本文对营卫之气的本义、生成、性质以及功能等内容进行探讨,进而明确营卫之间的阴阳关系。针对得气概念而言,通过对《内经》及后世医家的得气概念分析,总结出了得气的过程：针刺过程中,得气会发生两次。第一得气是进针时发生的腧穴中的卫气反应,而把刺激传到经气。此经气经过补泻等针刺措施可以调和阴阳使卫气与营气,阴阳相随,维持“阴平阳秘”的状态,由此形成的阴阳已调之经气才能到达病所或针下,这是第二得气。对这第二得气从经气与营卫之气的阴阳关系来看,经气分营卫二气,其中卫气起主导地位,从而得出：针灸治疗中所得气为卫气。第二部分为对留针暂久依据及卫气运行规律进行了探讨,通过分析《内经》和后世对留针的认识及得气与留针关系,寻求选择留针时间的依据,得出：留针时间之暂久应依卫气运行规律。因为,卫气功能旺盛具有周期性,此时间内至少能保证有一次卫气最盛的高潮,此时敏感性增加,功能强大,能更好地引导,制约经气到达病所,治疗效果好。而对营气和卫气运行规律系统进行探讨,明确营卫之气的运行形式及其间的关系,并对产生营卫之气“昼行25周,夜行25周”的昼夜节律性变化机理进行了探讨,由此,不但表明营卫之气的运行中卫气处于主导地位,而且说明了《内经》针刺治疗中卫气运行的意义。这为卫气随季节的运行变化研究作为理论依据。第三部分为对不同季节不同的留针时间进行探讨,根据《内经》卫气理论,通过卫气昼夜运行规律与二十八星宿和漏壶计时法的关系算出随季节变化的卫气运行速度变化为：卫气随四时昼夜时间长短显示不同运行速度。即“日行于阳二十五周”,冬季较夏季会快；“夜行于阴二十五周”,冬季较夏季会慢。而纬度越高,不同季节的卫气运行速度相差越大。在卫气运行速度季节性变化的理论基础上探讨对得气的留针量可变性,提出四时的白昼时留针时间是：以北京为例,一日一百刻,夏至需要2.5刻,即约36 min；冬至需要1.56刻,即约23min；春秋分需要2刻,即约29 min的时间。各季节的卫气运行一周时间就是该季节的留针时间。在针刺治疗时,把握卫气运行速度变化的规律,留针时间根据各季节的卫气运行速度不同,并采取适当的措施,就能得到更好的疗效,对针灸临床具有极其重要的意义。结语对本文的结论及创新点进行了总结,并对今后的研究进行了展望。更多还原

【Abstract】 DeQi (obtain Qi) and the needle retaining are premise for the efficacy of acupuncture treatment. But what Qi is obtained and how long the needle retaining should be has rarely been studied, leading to the clinical ignorance of the needle retaining time. Starting from literature review, this paper has in-depth discussions on the above two questions, aims to use the theories of《Yellow Emperor’s Canon of Internal Medicine》to explain the origin of DeQi and the basis of the needle retaining, and builds preliminary models for the needle retaining in four seasons in order to provide certain guidance over clinical acupuncture.This chapter starts analysis from the basic functions of Defending Qi as well as its relationship with Nourishing Qi, clearly points out that the Qi obtained in acupuncture treatment is Defending Qi, and then studies the relationship between the running of Defending Qi and the needle retaining time. Discussion is carried out from the perspective of seasonable variation of Defending Qi running speed and conclusion is reached that the needle retaining time should vary in the four seasons. Finally, preliminary models for the needle retaining in four seasons are built to play a part in the improvement of clinical efficacy. The paper is divided into three parts, including the conclusion:The first part analyzes the concepts of Defending Qi, Nourishing Qi and DeQi. Nourishing Qi and Defending Qi are a pair of important concepts in the Chinese medicine, and either cannot be explained separately from the other. Therefore, this paper discusses the two concepts together on their meaning, generation, nature, functions and other aspects, and then further clarifies the Yin-Yang relationship they have. As for the concept of DeQi, the paper analyzes the concept by referring to《Yellow Emperor’s Canon of Internal Medicine》and the definitions of later generations of Chinese medicine physicians, summarizes the progress of DeQi, and concludes that DeQi occurs twice in the process of acupuncture. DeQi occurs for the first time as Defending Qi response in acupoints when the needle is newly applied to spread the stimulation to JingQi. Then this JingQi can adjust the Yin and Yang of Defending Qi and Nourishing Qi by reinforcing and reducing as well as other acupuncture measures to achieve balance between the two and maintain the state where "Yin is even and well while Yang is firm". Thus the JingQi whose Yinyang has been adjusted can reach the disease focus or the point beneath the needle, and this is the second DeQi. As for the second DeQi, from the relationship between JingQi and Nourishing Qi and Defending Qi, it can be told that JingQi has two types—Nourishing Qi and Defending Qi, in which Defending Qi plays a dominant role. On this basis, conclusion is reached that DeQi in acupuncture treatment refers to Defending Qi.The second part discusses the basis for the needle retaining time and the running rules of Defending Qi, conducts analysis by referring to《Yellow Emperor’s Canon of Internal Medicine》and later generations of Chinese medicine physicians’understanding of the needle retaining and relationship between DeQi and the needle retaining, seeks the basis for the choice of the needle retaining time, and thus concludes that the needle retaining time shall be based on the running rules of Defending Qi. That’s because the functional vitality of Defending Qi is cyclical, each cycle at least has one primp peak of Defending Qi when the sensitivity is increased and functions are strong. If proper guidance is conducted at the right time, JingQi can be effectively led to the disease focus and good efficacy can be achieved. Then this part explores the running rules of Nourishing Qi and Defending Qi, makes clear their running forms and interrelation, and discusses the mechanism giving rise to the rhythm change of night and day featured by "diurnal 25 weeks, night 25 weeks" of running of Nourishing Qi and Defending Qi. After all these, it is further proved that Defending Qi plays a dominant role in the running of Nourishing Qi and Defending Qi, and the significance of Defending Qi in acupuncture treatment included in《Yellow Emperor’s Canon of Internal Medicine》is also demonstrated. This provides a theoretical basis for the study of seasonal variatiom of Defending Qi running.The third part discusses the different needle retaining time in different seasons, and according to the Defending Qi theory in Yellow Emperor’s Canon of Internal Medicine, the change in running speed of Defending Qi in different seasons is worked out by the running rules of Defending Qi during day and night and the relationship between twenty-eight constellations and drip-vessel timing method, which is: Defending Qi shows different running speeds with different lengths of day and night in the four seasons. To be more specific, "Daytime around at Yang twenty-five times", and Defending Qi runs faster in winter than in summer; "night around at Yin twenty-five times", and Defending Qi runs faster in summer than in winter. In addition, higher latitudes have greater differences in running speeds of Defending Qi in different seasons. Based on the theory of seasonal variation of running speed of Defending Qi, the paper explores the variability of the needle retaining amount of DeQi, and proposes that the needle retaining time during day in the four seasons should be as follows. Take Beijing as an example. If one day is 100 quarters, on summer solstice, it shall be 2.5 quarters or about 36 min; on winter solstice, it shall be 1.56 quarters or about 23 min; and on the Spring Equinox or Autumn Equinox, it shall be 2 quarters or about 29 min. In each season, the time Defending Qi takes to run one round is the needle retaining time in that season. In acupuncture treatment, the rules of Defending Qi running speed variations and the fact that the needle retaining time varies according to the running speed of Defending Qi in different seasons shall be kept in mind. In addition, appropriate measures shall be taken to achieve better efficacy, which is of essential significance for acupuncture clinics.The conclusion part summarizes the conclusions and innovative points of this paper, and explores future research directions.更多还原